58% of health expen­diture goes in rimdo or puja, finds BLSS, 2017

The highest share of health related expenditure, 58 percent, went into conducting religious ceremonies (rimdo or puja) according to the Bhutan Living Standards Survey (BLSS) 2017, reflecting the strong affinity of Bhutanese towards spirituality and the centrality of spiritual support.

Total transportation charges (for emergency and non-emergency) consti­tuted a fourth (25.1 percent) of the total health expenditure. The high propor­tion of transportation costs indicates that the indirect costs of getting treatment can be more significant than direct treatment costs (hospital charges, medicines, etc.).

The direct costs might be low because of free or subsidized services at gov­ernment health facilities. Purchase of medicine and health accessories accounted for about seven percent. Just eight percent of persons spend on other health-related expenditures.

With an average health expenditure of Nu 2,064 and Nu 1,408 respectively, expenditure is generally higher in urban areas (Nu 4,367) than in rural areas (Nu 3,428).

Besides rimdo and in-country transportation, child deliveries make up the largest proportion of the health expenditure.

About 6 percent or 11,025 women of reproductive age gave birth in the last 12 months, and teenage pregnancy in the rural area during the same period is 3.6 times that of the urban areas.

Among women of reproductive age (15–49 years), 125,944 (64.9 percent) have given birth at some point in their lives and teenage pregnancy is 6.4 times more likely in rural areas than in urban areas.

Over nine in ten women (90.9 percent) who gave birth in the past 12 months received antenatal care, while about 87 percent received postnatal care. About three-fourths of all women who gave birth in the past 12 months did so in a hospital or health facility, just over three percent gave birth at home without skilled attendants, and births away from home was insignificant.

In the urban areas, more than 98 percent of deliveries were in hos­pitals or health facilities; in the rural areas, only about 90 percent of deliveries were in such facilities. On average, households spend Nu 3,838 per delivery.

Among people who experienced some dif­ficulty in functioning in their everyday lives, problem encountered with seeing (5.6 percent) was the most prevalent, followed by mobility (3.7 percent) and hearing (3.5 percent).

Disability among females was more prevalent than males in almost all the domains. About two percent of the people had “moderate or severe disability” (at least some difficulty in one domain), while one percent experienced “severe dis­ability”. The prevalence rate for persons with mild disability was 11 percent.

The incidence of sickness or injury is higher in the urban areas. Females are also more susceptible to sickness or injury than males, irrespective of area (urban or rural).

The BLSS stated that in the 12 months before the survey, about 3 percent of the population had stayed at least overnight at a medical facility due to sickness or injury, with elderly persons more likely to stay overnight

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